Abstract： Objective To evaluate the feasibility, efficacy of the right-sided video-assisted thoracic surgery (VATS) apico-posterior transmediastinal approach for large blebs at the apes of both lungs in single-stage. Methods From October 2007 to June 2009, Singal-stage the right-sided VATS apico-posterior transmediastinal approach was carried out in 15 cases of primary spontaneous pneumothorax, treated by bilateral bullectomy. Results All the patients were treated successfully, the operating times ranged from 80 to 140 minutes. The average intra operative blood loss was 45 ml. The average of hospital stay was 7days. The duration of follow-up was 4 to 20 months, no death, and no recurrence. Conclusions Single-stage right-sided VATS, apico-posterior transmediastinal approach for bilateral bullectomy is a minimally invasive, effective and reliable method. Modification of the original technique of procedure and evaluation of long-term result require further study.